Infectious diseases now最新文献

英文中文

The 2024 cholera outbreak in Mayotte. Clinical and biological factors associated with severe forms of the disease in an observational cohort of 206 patients 2024年马约特霍乱爆发。在206例患者的观察队列中，临床和生物学因素与严重形式的疾病相关。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-25 DOI: 10.1016/j.idnow.2025.105163

Julien Carvelli , Coline Mortier , Mohamed Boucekine , Vincent Gilles , Yvonnick Boué , Guillaume Le Balle , Jeanne Broyon , Annabelle Lapostolle , Tanguy Cholin , Manon Dory , Chloé Andres , Renaud Piarroux , Louis Collet , Abdourahim Chamouine , Mohamadou Niang , for the CHOLEMAY Study Group

Objective

In 2024, the island of Mayotte (France) was affected by a cholera outbreak. The objective of this study was to identify clinical and laboratory criteria associated with severity (defined as hypovolemic shock and/or severe acidosis) in view of improving patient triage and therapeutic management in subsequent outbreaks.

Methods

From March 18 to July 12, 2024, we screened 215 patients with cholera (positive stool PCR). We excluded five patients who died outside hospital (no data, lethality = 2.3 %) and four patients for whom no data were available. We ultimately enrolled 206 patients. Severe forms of cholera were defined as the presence of at least one of the following three objective criteria: arterial hypotension; and/or neurological impairment (GCS < 14) (hypovolemic shock); and/or venous pH < 7.20 (severe acidosis) at first medical assessment.

Findings

Median patient age was 19 years (8–32 years), and 83 patients (40 %) presented with a severe form, which often consisted in fever (n = 13/83, 13 % vs. n = 6/123, 5 %, p = 0.04), vomiting (n = 71/83, 86 % vs. n = 79/123, 64 %, p < 0.001), a higher stool output (8 (4.5–10) vs. 4 (2–6) stools on day 1, p < 0.001) and severe hemoconcentration (Ht = 54 (47–60) vs. 43 (38–50), p < 0.001). In multivariate analysis, only hemoconcentration was associated with significantly greater severity (OR 95 % CI = 1.12 [1.04–1.21], p < 0.001).

Conclusion

Cholera is a toxin-mediated infection responsible for severe, occasionally fatal acute watery diarrhea. Severity is associated with neurological impairment, metabolic acidosis, and hemoconcentration. Triage and care of these patients are absolutely essential means of preventing death.

目的：2024年，法国马约特岛发生霍乱疫情。本研究的目的是确定与严重程度（定义为低血容量性休克和/或严重酸中毒）相关的临床和实验室标准，以便在随后的疫情中改善患者分诊和治疗管理。方法：从2024年3月18日至7月12日，对215例霍乱患者（粪便PCR阳性）进行筛查。我们排除了5例院外死亡患者（无资料，致死率 = 2.3 %）和4例无资料的患者。我们最终招募了206名患者。严重形式的霍乱被定义为至少存在以下三个客观标准中的一个：动脉低血压；和/或神经功能障碍（GCS < 14）（低血容量性休克）；和/或首次医学评估时静脉pH < 7.20（严重酸中毒）。发现:病人平均年龄为19 年(8-32 年),和83例(40 %)出现严重的形式,通常是在发烧(n = 13/83,13 %与n = 6/123,5 % p = 0.04),呕吐(n = 71/83,86 %与n = 79/123,64 % p 结论:霍乱是一种toxin-mediated负责严重感染,有时致命的急性水样腹泻。严重程度与神经功能损害、代谢性酸中毒和血液浓缩有关。对这些病人进行分类和护理绝对是预防死亡的必要手段。

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引用次数: 0

Precise identification and improved surveillance of influenza viruses circulating in Conakry (Guinea) 准确识别和改进在科纳克里（几内亚）流行的流感病毒监测。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-15 DOI: 10.1016/j.idnow.2025.105161

F.A. Traore , M.L. Kourouma , G. Camara , I.I.A. Idriss , N. Camara , P. Fenano , M.B. Keita

引用次数: 0

Prevalence of digestive carriage of multi-drug resistant enterobacterales in hospitalized and community-based patients in Togo: a prospective study 多哥住院和社区患者消化道携带多重耐药肠杆菌的患病率：一项前瞻性研究。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-10 DOI: 10.1016/j.idnow.2025.105160

Rogatien Comlan Atoun , Iman Frédéric Youa , Lidaw Déassoua Bawe , Isidore Tchaou , Bodombossou Madera , Awereou Kotosso , Alexandre Bleibtreu , Taïssiri Adedjouma , André Pouwedeou Bedekelabou , Jules Tchédié , Yvette Siliadin , Eric Cardinale , Laurence Armand Lefevre , Brücker Gilles , Salou Mounerou , Claver Anoumou Dagnra , Didier Koumavi Ekouevi , Dominique Salmon

Introduction

The aim of this study was to estimate the prevalence of digestive tract carriage of ESBL-E/CPE among patients having consulted or been hospitalized in two university hospitals in Lomé in 2023.

Methods

A cross-sectional study was conducted from January to June 2023. Rectal swabs were collected from 230 participants (100 in maternity, 50 in pediatrics, 50 in trauma-orthopedics, and 30 in intensive care).

Results

Median age was four years for children and 30 years for adults. Overall prevalence of ESBL-E carriage was 59.6 %, while that of CPB was 6.1 %. Carriage was more frequent in hospital settings than in the community (64.6 % vs. 53.0 %). The main isolated species were Escherichia coli (95.6 %) and Klebsiella pneumoniae (27.7 %). Hospitalization units were associated with multidrug-resistant bacteria carriage.

Conclusion

These findings highlight a high prevalence of digestive tract carriage in hospital as well as community settings.

前言：本研究的目的是估计2023年在lomoise两所大学医院就诊或住院的患者消化道携带ESBL-E/CPE的患病率。方法：于2023年1 - 6月进行横断面研究。收集230名参与者的直肠拭子（产科100名，儿科50名，创伤骨科50名，重症监护30名）。结果：儿童中位年龄为4岁，成人中位年龄为30 岁。ESBL-E携带的总患病率为59.6% %，而CPB为6.1 %。医院分娩比社区分娩更频繁（64.6 %对53.0 %）。主要分离种为大肠埃希菌（95.6% %）和肺炎克雷伯菌（27.7% %）。住院单位与多重耐药细菌携带相关。结论：这些发现突出了医院和社区环境中消化道运输的高患病率。

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引用次数: 0

An update of histoplasmosis focusing on Portuguese epidemiological specificities 组织胞浆菌病的最新情况，重点关注葡萄牙流行病学特异性。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-05 DOI: 10.1016/j.idnow.2025.105158

Raquel Sabino , Cristina Veríssimo , Francisco Antunes

引用次数: 0

Determinants of sustainable adoption in primary care of a clinical decision support system for antimicrobial prescribing: A qualitative study 抗菌药物处方临床决策支持系统在初级保健中可持续采用的决定因素：一项定性研究。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-05 DOI: 10.1016/j.idnow.2025.105157

N. Peiffer-Smadja , M. Thy , T. Delory , P. Jeanmougin , L. Giordano , J.Le Bel , E. Bouvet , Alison Helen Holmes , S. Lariven , R. Ahmad , F.X. Lescure

Objective

The objective of the study was to analyse the determinants for sustainable adoption by General Practitioners (GPs) of Antibioclic, a Clinical Decision Support System (CDSS) for antimicrobial prescribing, and the results of and limitations to its use in clinical practice.

Materials and methods

Individual interviews with GPs and a focus group were carried out concerning their use of Antibioclic, a CDSS for antimicrobial prescribing in primary care. Antibioclic is a publicly funded, freely available CDSS targeting 48 common infectious diseases. Interviews were recorded, transcribed and coded using NVivo 12. Data were analysed via inductive thematic analysis.

Results

Interviews were conducted with 25 GPs, and nine additional GPs participated in the focus group. Median age was 34 years (IQR 32–43) and 20 participants (59 %) were women. All of them frequently and sustainably used Antibioclic in their practice. Adoption of the CDSS was explained by system characteristics: usability, up-to-dating and trustworthiness; it was also considered as routinized, interwoven with consultations and antimicrobial prescribing, and conducive to improved practices and communication with patients. The GPs emphasized the role of CDSSs role in bridging the gap between clinical guidelines and daily practice, while contributing to contextual learning and continuous medical education. Lastly, participants pointed out the importance of co-design of CDSSs with end-users.

Conclusion

These determinants of sustainable adoption of a CDSS may guide future implementation of electronic tools in into clinical practice.

目的：本研究的目的是分析全科医生（gp）持续采用抗生素处方的临床决策支持系统（CDSS）的决定因素，以及其在临床实践中使用的结果和局限性。材料和方法：对全科医生和焦点小组进行个人访谈，了解他们使用抗生素的情况，这是一种用于初级保健抗菌药物处方的CDSS。抗生素是一种公共资助、免费提供的针对48种常见传染病的CDSS。使用NVivo 12对访谈进行记录、转录和编码。数据通过归纳专题分析进行分析。结果：对25名全科医生进行了访谈，另外9名全科医生参加了焦点小组。中位年龄为34 岁（IQR 32-43）， 20名参与者（59 %）为女性。他们在实践中都经常和持续地使用抗生素。系统的特点是：可用性、时代性和可靠性；它也被认为是常规化的，与会诊和抗菌药物处方交织在一起，有利于改善实践和与患者的沟通。全科医生强调了cdss在弥合临床指南和日常实践之间差距方面的作用，同时有助于背景学习和持续医学教育。最后，与会者指出与最终用户共同设计cds的重要性。结论：这些可持续采用CDSS的决定因素可能指导未来在临床实践中实施电子工具。

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引用次数: 0

Retrospective analysis of discharge antibiotic selection and 30-day readmission rate for community acquired pneumonia 社区获得性肺炎出院抗生素选择及30天再入院率的回顾性分析。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-05 DOI: 10.1016/j.idnow.2025.105159

Nick Hartwig , Eric Wombwell

Purpose

This study evaluates 30-day community-acquired pneumonia (CAP) readmission rates dependent on discharge antibiotic selection.

Patients and methods

This is a retrospective, single-center, observational study of patients discharged with a diagnosis of CAP from July 1st, 2022 through June 30th, 2023. Patients included those empirically treated with ceftriaxone plus azithromycin and with documentation of discharge antibiotics.

Results

Beta-lactam combination therapy represented the most frequent discharge antibiotic regimen (n = 161). Only 6/368 patients were re-admitted within 30 days. No significant difference was detected in readmission rates between beta-lactam and non-beta-lactam monotherapy (p = 0.921), or between combination therapy and monotherapy (p = 0.604). The average total duration of combined inpatient (4 days) and outpatient (5 days) antibiotic therapy was 9 days.

Conclusion

Broad-spectrum or combination antibiotic therapy at discharge did not result in lower readmission rates. The significant antibiotic stewardship opportunities that remain at transition from in-patient to out-patient care should prioritize narrow spectrum, short-course, monotherapy antibiotic regimens when the causative pathogen is unknown.

目的：本研究评估30天社区获得性肺炎（CAP）再入院率与出院抗生素选择的关系。患者和方法：这是一项回顾性、单中心、观察性研究，研究对象为2022年7月1日至2023年6月30日诊断为CAP的出院患者。患者包括经经验使用头孢曲松加阿奇霉素治疗并有出院抗生素记录的患者。结果：β -内酰胺联合治疗是最常见的出院抗生素方案（n = 161）。只有6/368例患者在30 天内再次入院。β -内酰胺与非β -内酰胺单药治疗的再入院率无统计学差异（p = 0.921），联合治疗与单药治疗的再入院率无统计学差异（p = 0.604）。住院（4 天）和门诊（5 天）抗生素治疗的平均总时间为9 天。结论：出院时广谱或联合抗生素治疗均未降低再入院率。在从住院到门诊护理的转变中，重要的抗生素管理机会应该优先考虑在致病病原体未知的情况下使用窄谱、短疗程、单药抗生素方案。

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引用次数: 0

Lung ultrasonography for community-acquired pneumonia diagnosis. 肺超声在社区获得性急性肺炎诊断中的应用。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-01 Epub Date: 2025-07-31 DOI: 10.1016/j.idnow.2025.105129

D Basille, Y Tandjaoui-Lambiotte, M Blot, P Fillatre, A Dinh, C De Margerie

Over the past two decades, several studies have assessed the performance of lung ultrasonography in the diagnosis of community-acquired pneumonia (CAP). The performance of this diagnostic tool, when used by clinicians other than radiologists, is excellent, with an area under the curve of 0.97, 92% sensitivity, and 93% specificity according to a recent meta-analysis including 5,108 patients. When ultrasonography is compared with chest CT-scan, sensitivity ranged from 68% to 98% and specificity from 61% to 98%. Compared with chest x-ray, ultrasonography seems more sensitive and specific. Lung ultrasonography can thus be considered a reliable tool for the diagnosis of CAP and may serve as a first-line imaging modality, provided that operators have received adequate training. Lung ultrasonography is particularly indicated in patients with acute respiratory failure, as good quality chest x-ray is difficult to perform in these patients. When diagnostic uncertainties remain after this radiological and clinical evaluation, low-dose chest CT-scan is recommended.

在过去的二十年中，一些研究评估了肺部超声检查在诊断社区获得性急性肺炎（CAP）中的表现。该诊断工具的性能，当临床医生使用，而不是放射科医生，是优秀的，曲线下面积为0.97,92%的敏感性和93%的特异性，根据最近的荟萃分析，包括5108例患者。与胸部ct扫描相比，超声检查的敏感性为68% ~ 98%，特异性为61% ~ 98%。与x线胸片相比，超声检查似乎更敏感、更特异。因此，肺超声检查可以被认为是可靠的CAP诊断，并且可以作为替代胸片的一线工具，只要操作者事先培训成功。肺超声检查特别适用于急性呼吸衰竭患者，因为在这些患者中很难进行高质量的胸部x线检查。当在放射学和临床评估后诊断仍不确定时，建议进行低剂量胸部ct扫描。

引用次数: 0

The pragmatic management of rabies risk in Operation DAMAN 50 (Lebanon, October 2024-February 2025): A case study for evidence-based military medicine in the field DAMAN 50行动（黎巴嫩，2024年10月- 2025年2月）狂犬病风险的务实管理：实地循证军事医学案例研究

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-08-21 DOI: 10.1016/j.idnow.2025.105136

T. Gasc , Y. Santinelli , J. Marti

The French Armed Forces are regularly deployed in areas of endemic rabies, a virus responsible for 59,000 deaths worldwide every year. During Operation DAMAN 50 at the end of year 2024, a rapid conflict intensification in southern Lebanon significantly increased rabies exposure of French servicemen and decreased access to laboratory analyses. Exposures of military personnel to scratches from cats of unknown rabies status multiplied, putting extreme strain on post-exposure prophylaxis (PEP) stocks. To minimize the risk of a PEP shortage and its consequences, medical personnel deployed in Operation DAMAN 50 adopted a pragmatic strategy that adapted existing recommendations to the situation. At the individual level, the watch-and-see PEP occurred only if veterinarian cat observation was possible. It relied on pathophysiological, epidemiological, environmental and operational data and despite the lack of reliable laboratory at that time. On the wider scale, the strategy involved controlling the feline population. Based on clinical field skills and global appreciation of original situations of military practitioners, it maintained operational capacity while reserving limited vaccine supplies to patients with greatest need.

法国武装部队定期部署在狂犬病流行地区，这种病毒每年在全球造成59,000人死亡。在2024年底DAMAN 50行动期间，黎巴嫩南部冲突迅速加剧，大大增加了法国军人接触狂犬病的机会，并减少了获得实验室分析的机会。军事人员暴露于狂犬病状况不明的猫的抓伤情况成倍增加，对暴露后预防（PEP）库存造成极大压力。为了尽量减少医务人员短缺的风险及其后果，部署在达曼50行动中的医务人员采取了一项务实战略，根据实际情况调整了现有建议。在个体层面，只有在有可能进行兽医猫观察的情况下，才会进行观察PEP。它依赖于病理生理、流行病学、环境和操作数据，尽管当时缺乏可靠的实验室。在更广泛的范围内，该策略包括控制猫科动物的数量。根据实地临床技能和全球对军事从业人员原始情况的了解，它保持了业务能力，同时为最需要的病人保留了有限的疫苗供应。

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引用次数: 0

Beta-lactam underdosing is not more frequent in COVID-19 than in non-COVID-19 critically ill patients COVID-19中β -内酰胺剂量不足的情况并不比非COVID-19危重症患者更频繁。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-08-21 DOI: 10.1016/j.idnow.2025.105137

Maeva Palayer , Juliette Bernier , Emmanuel Pardo , Franck Verdonk , Tomas Urbina , Emmanuel Bourgogne

Objectives

COVID-19 has been associated with high rates of ventilator-associated pneumonia relapse. Antibiotic underdosing due to augmented renal clearance (ARC) has been suggested as a possible contributing factor. This retrospective study compared plasmatic beta-lactam concentrations between critically-ill COVID-19 and non-COVID-19 patients.

Patients and methods

We included measurements for cefotaxime, ceftazidime, cefepime and piperacillin. A multivariable logistic regression model was used to identify variables associated with underdosing.

Results

All in all, 361 samples were included from 126 patients. Median concentrations did not differ between COVID-19 and non-COVID-19 patients for any molecule, nor did the rate of underdosing (38 % vs 42 %, p = 0.68). In a logistic regression model adjusting for age, gender, BMI, creatinine clearance and type of beta-lactam molecule, COVID-19 status was not associated with underdosing (OR = 0.83 [0.38–1.83], p = 0.997).

Conclusions

Although underdosing of most commonly prescribed beta-lactams occurred in more than one third of cases in critically-ill COVID-19 patients, this rate did not differ from non-COVID-19 patients.

目的：COVID-19与呼吸机相关性肺炎复发率高相关。由于肾脏清除率增强导致的抗生素剂量不足被认为是一个可能的因素。这项回顾性研究比较了COVID-19危重患者和非COVID-19患者血浆β -内酰胺浓度。患者和方法：我们纳入了头孢噻肟、头孢他啶、头孢吡肟和哌拉西林的测定。使用多变量逻辑回归模型来识别与剂量不足相关的变量。结果：126例患者共纳入361份样本。在COVID-19和非COVID-19患者中，任何分子的中位浓度没有差异，剂量不足率也没有差异（38 % vs 42 %,p = 0.68）。在调整年龄、性别、BMI、肌酐清除率和β -内酰胺分子类型的logistic回归模型中，COVID-19状态与剂量不足无关（OR = 0.83 [0.38-1.83],p = 0.997）。结论：尽管超过三分之一的COVID-19危重患者出现了最常用的β -内酰胺类药物剂量不足的情况，但这一比例与非COVID-19患者没有差异。

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引用次数: 0

The infected optimist: Tracing contagion in Voltaire’s Candide 受感染的乐观主义者：追踪伏尔泰的《老实人》中的传染病

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-08-21 DOI: 10.1016/j.idnow.2025.105134

Francesco Brigo

引用次数: 0

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